title: Continuous neuromuscular blockade is associated with decreased mortality in post-cardiac arrest patients.
abstract: OBJECTIVE
  Neuromuscular blockade may improve outcomes in patients with acute respiratory distress syndrome. In post-cardiac arrest patients receiving therapeutic hypothermia, neuromuscular blockade is often used to prevent shivering. Our objective was to determine whether neuromuscular blockade is associated with improved outcomes after out-of-hospital cardiac arrest.
  
  
  METHODS
  A post hoc analysis of a prospective observational study of comatose adult (>18 years) out-of-hospital cardiac arrest at 4 tertiary cardiac arrest centers. The primary exposure of interest was neuromuscular blockade for 24h following return of spontaneous circulation and primary outcomes were in-hospital survival and functional status at hospital discharge. Secondary outcomes were evolution of oxygenation (PaO2:FiO2), and change in lactate. We tested the primary outcomes of in-hospital survival and neurologically intact survival with multivariable logistic regression. Secondary outcomes were tested with multivariable linear mixed-models.
  
  
  RESULTS
  A total of 111 patients were analyzed. In patients with 24h of sustained neuromuscular blockade, the crude survival rate was 14/18 (78%) compared to 38/93 (41%) in patients without sustained neuromuscular blockade (p=0.004). After multivariable adjustment, neuromuscular blockade was associated with survival (adjusted OR: 7.23, 95% CI: 1.56-33.38). There was a trend toward improved functional outcome with neuromuscular blockade (50% versus 28%; p=0.07). Sustained neuromuscular blockade was associated with improved lactate clearance (adjusted p=0.01).
  
  
  CONCLUSIONS
  We found that early neuromuscular blockade for a 24-h period is associated with an increased probability of survival. Secondarily, we found that early, sustained neuromuscular blockade is associated with improved lactate clearance.
authors.affiliation: Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Justin D
authors.initials: JD
authors.lastname: Salciccioli
authors.forename: Michael N
authors.initials: MN
authors.lastname: Cocchi
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Peberdy
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
authors.forename: Benjamin S
authors.initials: BS
authors.lastname: Abella
authors.forename: David F
authors.initials: DF
authors.lastname: Gaieski
authors.forename: John
authors.initials: J
authors.lastname: Clore
authors.forename: Shiva
authors.initials: S
authors.lastname: Gautam
authors.forename: Tyler
authors.initials: T
authors.lastname: Giberson
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.forename: Michael W
authors.initials: MW
authors.lastname: Donnino
mesh_terms: D000140:Acidosis, Lactic / Q000517:prevention & control; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007773:Lactates / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D007773:Lactates
keywords: Cardiac arrest; Lactic acidosis; Neuromuscular blockade; OHCA; Shock